Manage drug-induced parkinsonism through early recognition of the condition and discontinuation of the causative agent
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Manage drug-induced parkinsonism through early recognition of the condition and discontinuation of the causative agent Parkinsonism can be induced by many drugs, particularly dopamine receptor antagonists. Key strategies for managing drug-induced parkinsonism include prompt diagnosis and discontinuation or replacement of the offending drug. If symptoms persist, pharmacotherapy and electroconvulsive therapy are options.
Prevalence is increasing Drug-induced parkinsonism is a reversible, pharmacotherapy-induced, rigid-akinetic syndrome that develops as a result of diminished stimulation of dopamine D2 receptors in the striatum.[1] Although estimations of the prevalence and incidence of the condition vary greatly, its prevalence appears to be growing as populations age and use of polypharmacy increases. Drug-induced parkinsonism is now considered to be the most widespread secondary parkinsonism in Western countries, yet is still under-recognized and could become a considerable future health concern. This article summarizes a recent review on the prevention and management of druginduced parkinsonism by Lo´pez-Sendo´n et al.[1]
Drug-induced parkinsonism generally occurs within the first 3 months after drug exposure and has variable clinical features.[1] Akinesia (with arm swing loss) and bradykinesia are common early symptoms of drug-induced parkinsonism, although patients will not necessarily have all of the chief clinical features of idiopathic Parkinson’s disease, with tremor, rigidity and bradykinesia rarely being seen in combination. However, in some individuals, drug-induced parkinsonism may be indistinguishable from idiopathic Parkinson’s disease and other parkinsonisms, as the clinical characteristics of these syndromes overlap. Differential diagnosis of drug-induced parkinsonism may be facilitated by checking for several distinguishing clinical features (table I).[1]
Some are particularly susceptible In the elderly, drug-induced parkinsonism is considered to be the second most common cause of parkinsonism after idiopathic Parkinson’s disease.[1] Older individuals may be particularly prone to developing drug-induced parkinsonism because of age-related pharmacokinetic changes, inadequate
Table I. Clinical features, including functional neuroimaging tests, that distinguish drug-induced parkinsonism and idiopathic Parkinson’s disease[1] Feature
Drug-induced parkinsonism
Idiopathic Parkinson’s disease
Age at onset
More common in the elderly
Sixth decade
a
Typically asymmetrical
Symptoms at onset
Typically symmetrical
Onset
Acute or subacute
Chronic
Course with treatment
Reversible
Progressive
Response to causative agent withdrawal
Variable
Poor
Response to levodopa
Poor
Marked
Other features
Orofacial dyskinesia, akathisia
Rest tremor
Uncommonb
Gait abnormalities
Common
Only after years of progression
Sex
More common in females
More common in males
Uncommon
Commonc
Freezing
Common
DaTscan
Normal
Abnormal
PET/SPECT imaging
Normal uptake of presynaptic markers; reduced upt
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